Posted on May 19, 2013
Original Medicare and Medicare private health plans, also known as Medicare Advantage plans, must cover emergency services even if your condition didn’t turn out to be an emergency. You can appeal if your plan refuses to pay for your ambulance ride.
You can also go to any hospital or use any ambulance company in an emergency situation, whether or not they’re in your plan’s network.
Medicare Part B covers emergency ambulance transportation from your home (or another place where the need arose) to a hospital. Medicare will also cover ambulance rides to and from other locations.
If your plan won’t pay for your ambulance ride, you can appeal. You must get a written denial from your plan before you can appeal. You then have 60 days from the date on the denial notice to appeal.
In your appeal, you should include a letter explaining that you thought you were having a heart attack and that the ambulance service was medically necessary. If possible, you should also include a letter of support from your doctor. This is the first step in the appeals process. It’s called requesting a reconsideration.
After you request a reconsideration, the plan has 60 days to respond. If the plan doesn’t respond, or the plan doesn’t agree to cover the service, you can continue your appeal to the next level. There are several more levels of appeal after a reconsideration that you can use.